Instructional course lectures
-
The management of acute scaphoid fractures should be oriented on the concept of fracture stability, ease of reduction, associated ligamentous injury, and risk of impaired blood supply, rather than the direction of the fracture line or location of the fracture within the scaphoid. The lack of predictability of successful fracture union and prognostic discrepancies of historic and contemporary classifications may be related to subtle differences of the internal vascular architecture of each scaphoid. ⋯ Improved healing rates in a shorter time and earlier rehabilitation with percutaneous techniques of internal fixation have produced a clear shift from classic conservative treatment to internal skeletal fixation. Although the rates of union of well-vascularized nonunions have not been dramatically improved with the use of internal fixation as compared with inlay bone grafting, the restoration of scaphoid anatomy and prevention of malunion and associated carpal collapse with interpositional bone grafting techniques will reduce the risk of osteoarthritis.
-
Patellofemoral complications following TKA are largely avoided with proper surgical technique. A variety of surgical exposures, including the midvastus and subvastus approach, has resulted in good clinical success. It is critical to maintain the integrity of the extensor mechanism. ⋯ Proper patellofemoral tracking must be obtained at the time of the primary TKA. The diagnosis and treatment of the more frequent complications of the extensor mechanism following TKA have been discussed. Although these complications may be successfully treated, most may be largely avoided with proper surgical technique and prosthetic component design.